Prognostic significance of nonischaemic myocardial fibrosis in patients with normal left ventricular volumes and ejection-fraction

Lota, A. S. et al. (2021) Prognostic significance of nonischaemic myocardial fibrosis in patients with normal left ventricular volumes and ejection-fraction. JACC: Cardiovascular Imaging, (doi: 10.1016/j.jcmg.2021.05.016) (In Press)

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Abstract

Objectives: This study aims to investigate the prognostic significance of late gadolinium enhancement (LGE) in patients without coronary artery disease and with normal range left ventricular (LV) volumes and ejection fraction. Background: Nonischemic patterns of LGE with normal LV volumes and ejection fraction are increasingly detected on cardiovascular magnetic resonance, but their prognostic significance, and consequently management, is uncertain. Methods: Patients with midwall/subepicardial LGE and normal LV volumes, wall thickness, and ejection fraction on cardiovascular magnetic resonance were enrolled and compared to a control group without LGE. The primary outcome was actual or aborted sudden cardiac death (SCD). Results: Of 748 patients enrolled, 401 had LGE and 347 did not. The median age was 50 years (interquartile range: 38 years-61 years), LV ejection fraction 66% (interquartile range: 62%-70%), and 287 (38%) were women. Scan indications included chest pain (40%), palpitation (33%) and breathlessness (13%). No patient experienced SCD and only 1 LGE+ patient (0.13%) had an aborted SCD in the 11th follow-up year. Over a median of 4.3 years, 30 patients (4.0%) died. All-cause mortality was similar for LGE+/- patients (3.7% vs 4.3%; P = 0.71) and was associated with age (hazard ratio: 2.04 per 10 years; 95% confidence interval: 1.46-2.79; P < 0.001). Twenty-one LGE+ and 4 LGE- patients had an unplanned cardiovascular hospital admission (hazard ratio: 7.22; 95% confidence interval: 4.26-21.17; P < 0.0001). Conclusions: There was a low SCD risk during long-term follow-up in patients with LGE but otherwise normal LV volumes and ejection fraction. Mortality was driven by age and not LGE presence, location, or extent, although the latter was associated with greater cardiovascular hospitalization for suspected myocarditis and symptomatic ventricular tachycardia.

Item Type:Articles
Additional Information:Supported by the Cardiovascular Research Centre at Royal Brompton and Harefield NHS Foundation Trust, the National Heart and Lung Institute, Imperial College London, the Alexander Jansons Myocarditis UK and the Wellcome Trust. Dr Lota was funded by a British Heart Foundation Clinical Research Training Fellowship (FS/17/21/32712). Dr Prasad has received funding from the Alexander Jansons Myocarditis UK, Rosetree Trust, British Heart Foundation, the Medical Research Council and the Coronary Artery Disease Research Association; and has received honoraria for talks from Bayer Schering. Dr Pennell has received research support from Siemens, has performed consultancy work for Bayer and Apotex and is a stockholder of CVIS. Dr Cleland has received non-financial research support from BSCI and Medtronic and speakers’ honoraria from Medtronic. Dr Cook is a consultant for Illumina and a shareholder in Enleofen Bio.
Status:In Press
Refereed:Yes
Glasgow Author(s) Enlighten ID:Cleland, Professor John
Authors: Lota, A. S., Tsao, A., Owen, R., Halliday, B. P., Auger, D., Vassiliou, V. S., Tayal, U., Almogheer, B., Vilches, S., Al-Balah, A., Patel, A., Mouy, F., Buchan, R., Newsome, S., Gregson, J., Ware, J. S., Cook, S. A., Cleland, J. G.F., Pennell, D. J., and Prasad, S. K.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
Journal Name:JACC: Cardiovascular Imaging
Publisher:Elsevier
ISSN:1936-878X
ISSN (Online):1876-7591
Published Online:14 July 2021
Copyright Holders:Copyright © 2021 The Authors
First Published:First published in JACC: Cardiovascular Imaging 2021
Publisher Policy:Reproduced under a Creative Commons License

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